Barriers and enablers to sustainable anaesthetic practice: a mixed-methods study

BACKGROUND: Anaesthetic practices contribute significantly to the environmental impact of healthcare. Using local or regional anaesthesia instead of general anaesthesia, and TIVA instead of inhalation anaesthesia, can reduce this impact. This study investigated why general anaesthesia is sometimes used over local and regional anaesthesia, and why inhalation agents are often chosen over TIVA. METHODS: We conducted a mixed-methods study in the UK (June 2023-April 2024), underpinned by the Theoretical Domains Framework. Semi-structured interviews (n=19) with anaesthetists, surgeons, and nurses of differing seniority were analysed using Framework Analysis. A national survey (n=347), distributed via posters and professional networks, was developed from early interview findings. Quantitative data were analysed descriptively and open-text responses were coded using the qualitative framework. RESULTS: Four key themes were identified: (1) contextual factors affecting anaesthesia decision making; (2) patient differences and preferences; (3) influence of key decision makers on anaesthesia choice; and (4) default practices and lack of confidence in alternatives. These encompassed 17 subthemes and mapped to 9 of 14 Theoretical Domains Framework domains. CONCLUSIONS: This study provides new insights into behavioural influences underlying anaesthetic practice, which can inform the design of interventions to improve the sustainability of anaesthesia, without compromising patient safety and comfort. Addressing systemic and behavioural barriers through dedicated local anaesthesia operating lists, improved patient communication, targeted training, and supportive technologies may enhance efficiency while promoting safe, sustainable, patient-centred practice. Future interventions should be co-designed with surgeons, anaesthetists, and patients to ensure clinical acceptability, feasibility, and sustainability.